3. Pneumonia Acute. Of sixteen cases of this disease, three died, and a fourth remained doubtful. They were all accompanied by great congestion of blood, not only in the chest, but in the abdomen and other parts, rendering the treatment very difficult. One, two, or three general bleedings were followed by leeches to the chest, or to whatever part appeared to be the seat of congestion. In six cases only were blisters applied. Diminution of the force and frequency of the pulse; of the râle crepitant; of the dull sound; of redness on the cheeks; and, on the other hand, the facility of expectoration were the signs for discontinuing depletion, and trusting to the efforts of nature. If, after these favourable phenomena appeared, there was heard any râle in any part of the chest, then a blister was applied. Mean stay in hospital for pneumonia was 22 days. The first of the three fatal cases died on the fifth day after he was received into hospital, having been ill for twelve days previously. The depletive system was pursued as far as was consistent with prudence, but it was too late. On dissection, considerable portions of lung were found hepatized, and much muco-purulent matter could be squeezed from the rest. The brain was sound; but the mucous membrane of the stomach was highly inflamed, and there were ulcerations in the ileum. The second patient, whose case proved fatal, had been ill only four days, according to his own account. When received, the dyspnoea was great, and he was spitting up bloody expectoration, with hard full pulse, great heat of skin, and ardent thirst. One general and one local bleeding somewhat relieved these symptoms; but the inflammation spread to the digestive apparatus, and required many leechings. The patient appeared to be convalescing, when a relapse took place, and then all means failed. On dissection, the posterior half of the left lung was found hepatized, and a considerable portion of the other lung was in the same condition. The mucous membrane of the stomach was softened, and there were marks of inflammation in the mucous membrane of the small intestines. Before taking up the subject of chronic inflammation of the lungs, M. Broussais thinks it necessary to say a few words respecting those acute thoracic inflammations which were on the point of changing into chronic, and which would have certainly induced phthisis, had it not been for the rigid antiphlogistic means that were used. Of 200 patients that entered the hospital during five months, and who were affected with pulmonary inflammation, only one has died of phthisis. In eleven cases, however, the inflammation proved obstinate, and phthisis was menaced. The following are the signs, M. B. observes, which indicate that chronic inflammation is taking place, to end in pulmonary phthisis. When patients, relieved from the acute symptoms, and especially from those of gastric irritation, begin to recover their appetite-become cheerful-and regain some degree of strength. They think themselves well, in fact, and regard the remaining cough as nothing. But the attentive physician will readily perceive, that, notwithstanding these appearances of amelioration, a focus of inflammation remains. There will be found some râle muqueux or râle sibilant, or both-the sound will be less clear, on percussion, over these points of the chest-the breathing will not be quite free-the chest will be raised, en masse, on inspiration; or one side will rise more than the other-the cough still continues, though much diminished--there is expectoration of a yellow mucus, or muco-purulent fluid--the pulse is more frequent than natural, and more full, especially towards evening--there is some pain or uneasiness complained of, under the sternum, at the epigastrium, or in the throat---the skin is dry and hot in the day, and often covered with perspiration in the night-the features of the countenance indicate some internal suffering, however the patient may endeavour to conceal it, which he almost always does. When patients are examined by the stethoscope they will breathe remarkably low, lest the wheeze (rale) should be heard. In short, they take every means of misrepresenting their actual condition, lest they should be deprived of food, and put upon rigid regimen. In these cases, the Professor was obliged to have repeated recourse to leeches under the clavicles, over the sternum, and other parts of the chest, wherever the wheeze could be most distinctly heard with the ear. To these means, were added blisters and severe regimen-chiefly milky and farinaceous food. If the appetite became very keen, although the pulmonary affection was not entirely dissipated, some bouillie was allowed, and, in this manner, they were kept under regimen for 10, 15, or 20 days. Nine out of these eleven patients were discharged cured, in the course of March and April, 1827. The other two remained a long time doubtful, and one appears not yet secure; the other has, ultimately, been saved from phthisis, though of a highly strumous habit, and consumptive family. 4. Chronic Bronchitis. In a considerable proportion of these cases, regimen alone succeeded; with the aid of some trifling narcotics. In some cases, it was necessary to employ local, and even general bleeding. By these means, all the cases recovered. The same may be said of the other chronic phlegmasiæ of the chest. 5. Acute Gastro-Enteritis. Of sixty cases of this disease, one proved fatal. In almost all the other cases, the disease gave way to the first, second, or third application of leeches-a few resisting the antiphlogistic treatment for a longer time. The complaint commenced with thirst, loss of appetite, general malaise, sense of heat at the epigastrium, redness of the point of the tongue, occasionally by vomiting, slight delirium, vertigo, &c. Some were taken suddenly and violently ill-others were slowly affected. Fourteen or fifteen of these cases are denominated, on the books of the hospital, "gastric irritations," being simple gastro-enterites, following a very rapid course. The symptoms of these were:-Cephalalgia, general sense of fatigue, inappetency, redness of the tip of the tongue, thirst, heat of epigastrium, some elevation and frequency of the pulse. Four of these cases ceded to regimen alone the others to ten, fifteen, or VOL. VIII. No. 15. 20 twenty leeches applied to the epigastrium, seconded by rigid abstinence, and emollient mucilaginous drink. In four cases, the disease presented itself in the form of inflammatory fever, and two of them required general bleeding, in addition to the leechings. In one case, the fever was on the point of passing into the adynamic (or what is here called typhoid) state; but two applications of leeches, one of 30 and the other of 10, to the epigastrium, hypochondria, and chest, with friction of vinegar, &c. arrested the progress of the stupor, and saved the patient from a dangerous form of disease into which he was lapsing. In two cases, there were presented the symptoms of what the ancients denominated ileus, without knowing its cause. This was a sudden development of a circumscribed tumour in the abdomen, accompanied by vomiting and most painful colic, &c. In one case, that of a young man, aged 29 years, the tumour appeared suddenly in the night, and to ease the pain, he had swallowed a quantity of brandy and sweet oil, which were soon thrown up by vomiting. Next day, leeches were plentifully applied to the tumour, followed by fomentations. On the succeeding day, there was neither vomiting, pain, nor tumour. The bowels were opened, and, in a few days, he was discharged cured. In the other case, the patient being a man 52 years of age, the pain was not very acute, but the vomiting was very frequent. This man had also swallowed some hot brandy and oil, which increased the sickness. The tumour was very sensible to the hand, as well as to the eye, being situated in the region of the caput coli. The pain was like that in colica pictonum, but dreadfully severe, and he begged for speedy relief from his sufferings. Twenty leeches were applied to the part. Next day, all the symptoms, and all traces of the tumour had disappeared. M. Broussais does not say much as to the real or supposed nature of these tumours in the abdomen. He thinks there is evidently acute inflammation-and possibly invagination— both of which speedily cede to the only proper mode of treatment; copious leechings and fomentations. He makes no mention of any accumulations in the colon, as the probable cause of these sudden tumours. We have seen several instances of this complaint-and one lately, in the person of a medical student of the Middlesex Hospital. He was, at one time, in a dangerous predicament, having neglected the complaint for a day or two. He required repeated local and general bleeding, with fomentations, calomel and opium, and smart purgation, when the disease yielded; but not before his face had assumed the Hippocratic cast, and the pulse had remained for more than 24 hours above 160 in the minute. He was judiciously treated in the beginning, by Mr. Weatherfield of Covent Garden, before we saw him. There were some serious complications of these gastro-enterites. The most formidable was erysipelas supervening on, or succeeding, the fever occasioned by the gastro-enteric affection. Yet, even in these cases, M. Broussais did not hesitate to apply numerous leeches to the cutaneous inflammation-and, it appears, with perfect success. The following are the principal features of the gastro-enteritis which proved fatal. The patient was in a desperate condition when he entered the hospital on the 12th November. When examined, his countenance had a very bad appearance-he was propped up in bed, breathing with much difficulty; tongue dry and red; thirst ardent ; total loss of appetite; much wheezing in the right side of the chest, which seemed depressed; deafness; diarrhoea. He was bled from the arm, and leeches were applied to the epigastrium and anus; glysters were thrown up, and various means were used, but in vain. He died on the 20th of the same month. On dissection, the mucous membrane of the stomach was found of a dark brown colour, and the lower portion of ileum was studded with innumerable ulcerations. The rest of the intestines were sound; but the right lung was completely disorganized, and contained several excavations. 7. Acute Duodenitis. There were seven distinctly marked cases of duodenitis, and five where it accompanied other affections. In all but three of these cases, there was general jaundice. None proved fatal. In two cases, the disease appeared to be brought on by paroxysms of anger. The characteristic features were, a loaded tongue, (the crust of fur being of a grey, white, or greenish cast) bitter taste in the mouth; great diminution, or total loss of appetite; a shining puffiness (renitence) in the region of the duodenum, seldom accompanied by pain. The treatment consisted in the application of 8, 10, 15, 20, or 30 leeches to the duodenal region. In the majority of cases, one application was sufficient. To this measure, warm baths were sometimes added, which helped to dissipate the jaundice. In these cases, starvation was indispensable, till the duodenitis ceased. 8. The cases of Colitis, eight in number, were easily removed by one or two applications of leeches. Diarrhoea was the characteristic feature. Rice gruel and rice pudding were found the best species of aliment. The cases of chronic gastro-enteritis were few in number, and offered nothing particular in symptoms or treatment. Regimen is, in these cases, the main spring of the cure. The other diseases in the table, do not require any particular notice. The following statement, from the records of the VAL DE GRACE, is certainly very favourable to the new physiological doctrine, and we entertain no doubt whatever of the superiority of the practice inculcated by this doctrine over the old routine of stimulants and tonics, in chronic diseases" medecine expectante" in acute. The ratio of mortality was thus: March, 1804 to December, 1809, 1 in 12 1 in 10 1 in 32 1 in 27 1 in 30. Annales de la Medecine Physiologique, Mai, 1827. 9. CURIOUS SPECIES OF CEREBRAL HÆMORRHAGE. [M. Bravais. L'Hospice be Bicêtre.] This There is, says M. Bravais, a disease of the cortical substance of the brain, to which anatomists and pathologists have not directed sufficient attention. It is a hæmorrhage which generally occupies the whole of the cortical substance of the brain, giving place, first, to the formation of some small globules of blood, mixed with the nervous pulp, and afterwards producing yellowish cicatrices, extending from the external coverings of the brain down to the medullary matter. lesion has an intimate connexion with cerebral hæmorrhage. symptoms, at all times obscure, have not been distinguished when the disease was bounded to a small portion of brain. They are such as appertain to congestion and softening of the cerebral substance. Sanguineous effusions into the cortical structure, are described by all authors; but M. Bravais has not seen any description answering to those yellow membranous-looking cicatrices which are now to be delineated. The Case 1. Pinard, aged 32 years, presenting, for several years, the symptoms of sombre melancholy, was observed to become rapidly emaciated during the last month of his life, and he complained much of pain in the right side of the chest, without any expectoration. He refused his food, and died on the 5th April, 1824. Dissection. There was a moderate proportion of blood in the sinuses and meninges of the brain; very little serosity on the surface of the hemispheres, or in the ventricles. The arachnoid and pia mater were transparent, and easily detached from the surface of the brain. In the posterior lobe of the left hemisphere, was found a crude tubercle, of small size, which readily turned out with its investing membrane. Around this tubercle, the cortical substance of the brain was reduced to a pulp, of a dark colour, in which the debris of the cerebral structure was discernible, mixed with some globules of blood. The rest of the brain preserved its usual consistence. The lungs, especially on the right side, were filled with miliary tubercles, and the bronchial glands were tuberculous. The narrator thinks it evident, that the cerebral tubercle, and the hæmorrhagic condition of the surrounding part, came on in the latter stage of this man's existence, and had nothing to do with the melancholic affection under which he so long laboured. Of this, we do not see the evidence so very clearly. Knowing the slow growth of tubercles generally, we do not see any reasonable doubt, that the one situated in this man's brain, may have contributed to the disturbance of the sensorial functions. Case 2. Dupille, aged 50 years, entered the Bicétre, on the 15th May, 1824, with the following symptoms :-Delirium, loquacity, constant motion of his limbs. The strait waistcoat was applied. 20th May. Considerable dyspnoea; delirium; coldness of the extremities; feeble |